| Disease or condition | Suitable medication during pregnancy | Note |
|---|---|---|
| Acne | Preparations containing isotretinoin must be stopped at least one month before reliable contraception is discontinued. Topical retinoids should not be used during pregnancy, and it is recommended to stop using them already when planning pregnancy. | |
| Allergy | Primarily topical medication (cromoglycate, glucocorticoids) | Preparations containing pseudoephedrine to be avoided. Hyposensitization therapy that has been started before pregnancy may be continued during pregnancy. |
| Asthma | Basic medication: an inhaled glucocorticoid and a short-acting beta2-agonist If a good therapeutic response has previously been obtained with long-acting beta2-agonists or leukotriene receptor antagonists, there is no obstacle to their use during pregnancy Systemic glucocorticoids, as necessary | Proper management of asthma during pregnancy is important. In general, the same basic principles in the management of asthma apply for both pregnant and non-pregnant women. Systemic glucocorticoid therapy:
|
| Bacterial infections Treatments for Symptomatic Urinary Tract Infections during Pregnancy | Penicillins, penicillin derivatives and cephalosporins Nitrofurantoin (must not be used if G6FD deficiency) Metronidazole (primarily topical treatment) | Trimethoprim and sulpha-trimethoprim products should be avoided when planning pregnancy and in early pregnancy. Tetracyclines should be avoided (risks are highest during 2nd and 3rd trimester). Fluoroquinolones should be restricted to special situations (clear indications, short-term use). In sporadic studies, the use of macrolide group antibiotics in early pregnancy has been associated with an increased risk of a congenital heart disease, but the association has not come up in all studies, nor has the causal connection been confirmed. |
| Crohn's disease, ulcerative colitis | Of TNF-alpha inhibitors infliximab and adalimumab | It is important to have the disease in remission during pregnancy. The placental penetration of infliximab and adalimumab increases from the second trimester onwards, and the neonate's medication concentration may be higher than the mother's. Azathioprine, mercaptopurine (6MP): Examination of the TPMT and, when considered necessary, NUDT15 gene activity before the start of the treatment |
| Lipid-lowering drugs | Not to be used during pregnancy or breastfeeding (Cholestyramine treatment possible; intake of fat-soluble vitamins should be ensured) | HMG CoA reductase inhibitors (statins) are discontinued at the latest when the pregnancy is confirmed. |
| Analgesics and antipyretics | Paracetamol is the first choice and usable during the whole pregnancy, but unnecessary use should be avoided. Regular, long-term use should always be discussed with a physician. | Use of paracetamol during pregnancy has been associated with the increased risk of cryptorchidism, ADHD and autism, the association has not been confirmed. Excessive use of NSAIDs when planning a pregnancy may decrease fertility, and excessive use during early pregnancy may possibly increase the risk of miscarriage. Repeated use of NSAIDs from the 20th week of pregnancy onwards should be avoided (adverse effect on the maturation of foetal renal function from the 20th week of pregnancy onwards and on the premature closure of the ductus arteriosus from the 28th week of pregnancy onwards). COX-2 selective NSAIDs are contraindicated during all phases of pregnancy. |
| Malaria prophylaxis The Safety of Antimalarial Drugs in Pregnancy, Drugs for Malaria in Pregnant Women | Consider drug resistance status of the geographical area. Chloroquine and proguanil Doxycycline (not after 14 weeks of pregnancy) | Travelling in malaria-endemic areas should be avoided during pregnancy. Protective clothing is important There is little experience with the use of atovaquone during early pregnancy. |
| Depression | Other possible drugs: bupropion, duloxetine, mirtazapine, venlafaxine, out of tricyclic antidepressants amitriptyline, nortriptyline | Use of antidepressive medication must be clearly indicated - good treatment of mother's depression is essential. May cause in the newborn drug-induced symptoms which usually resolve rapidly but may also be severe. Routine discontinuation of a drug important for the mother is not recommended late in pregnancy. Breastfeeding is usually possible (doxepin contraindicated). |
| Anthelmintics (pinworm) | No significant systemic absorption | |
| Migraine attack | NSAIDs (see also Analgesics and antipyretics) Sumatriptanonly for occasional use | There is little experience of repeated use of highly specific drugs. Ergotamine derivatives are contraindicated. |
| Migraine prophylaxis | ||
| Heartburn and hyperacidity | Antacids and sucralfate Famotidinefor short-time use (less experience) | Misoprostol is contraindicated. |
| Pregnancy nausea | Non-pharmacological treatments are preferable in the treatment of pregnancy nausea. Use of metoclopramide should generally be limited to 5 days in order to minimize neurological adverse effects (extrapyramidal symptoms). In pregnancy nausea the need for medication may be more long-term and assessed at physician's discretion. There is conflicting evidence on the safety of ondansetron; if possible start only after the 10th week of pregnancy. | |
| Fungal infections Topical Treatment for Vaginal Candidiasis in Pregnancy | Antifungal medicines applied to the skin (e.g. clotrimazole, miconazole, terbinafine on a limited area) For oral fungal infections nystatin | Oral fluconazole (single dose 150 mg) has in sporadic studies been associated with an increased risk of miscarriage / foetal death. The use to be limited on the basis of a physician's opinion and to situations where treatment response is not reached with a vaginally administered preparation. Repeated use of systemically administered antifungal drugs should be restricted to severe situations only. |
| Scabies, head lice | Systemic absorption marginal | |
| Insomnia | Preferably non-pharmacological management Of benzodiazepines oxazepam | Repeated use of tranquilizers or hypnotics should be avoided. Regular use during late pregnancy may cause drug-related symptoms in the newborn. Use of melatonin is not recommended during pregnancy and breastfeeding. |
| Hypertension Antihypertensive Drug Therapy for Mild to Moderate Hypertension during Pregnancy, Drugs for Rapid Treatment of Very High Blood Pressure during Pregnancy, Beta-Blockers for Mild to Moderate Hypertension in Pregnancy | Drugs affecting the renin-angiotensin system (ACE inhibitors, angiotensin receptor blockers) are contraindicated; the medication should be discontinued when pregnancy is planned, and at the latest when the pregnancy is confirmed. |
| Drug | Adverse foetal effect | Note |
|---|---|---|
Significant risk (25%) of severe malformation (particularly heart, CNS, facial and cranial bones) related to exposure in early pregnancy Possible risk of developmental delay | Restriction and supervision of the use of medication Reliable contraception should be taken care of before starting to use the medication. The following withdrawal periods should be observed before stopping reliable contraception:
acitretin 3 years.
| |
Hyperplasia of the clitoris | Risk from the 10th week of pregnancy onward | |
Possible increased risk of failure of neural tube closure | - | |
| Antiepileptic drugs | ||
| The regular follow-up of drug concentrations during pregnancy and, if necessary, a dose increase are important. Especially lamotrigine but also oxcarbazepine and levetiracetam concentration can decrease considerably as pregnancy advances, and may predispose to seizures. Similarly, in accordance with concentration determination the dose is restored after delivery gradually to the antepartum level. A mother with epilepsy should be followed-up at a maternity outpatient department. | ||
Valproate (valproic acid) | Risk of significant malformation is 3- to 8-fold (10-24%) compared to "background risk" (3%)
| The patient must commit to a pregnancy prevention programme http://www.ema.europa.eu/en/news/prac-recommends-new-measures-avoid-valproate-exposure-pregnancy Use of valproate during pregnancy contraindicated without compelling reason (epilepsy that requires pharmacotherapy and no other drug options) Start folic acid supplementation 0.4-4 mg already when planning pregnancy. From week 12 of pregnancy onwards the daily dose should not exceed 0.4 mg. Structural ultrasound examination at week 19-21 of pregnancy |
| Carbamazepine | Risk of significant malformation is about 2-fold (6%) compared to "background risk" (3%) The risk of neural tube defects is 0.5%. | Use must be based on a serious indication (epilepsy). Start folic acid supplementation 0.4-4 mg already when planning pregnancy. From week 12 of pregnancy onwards the daily dose should not exceed 0.4 mg. Structural ultrasound examination at week 19-21 of pregnancy |
| Phenytoin | Risk of significant malformation is about 2-fold (6%) compared to "background risk" (3%). Hypoplasia of distal phalanges, possibly cheilopalatoschisis, cardiac malformations | Use must be based on a serious indication Start folic acid supplementation 0.4-4 mg already when planning pregnancy. From week 12 of pregnancy onwards the daily dose should not exceed 0.4 mg. Structural ultrasound examination at week 19-21 of pregnancy |
| Topiramate | Increased risk of malformations, especially with regard to cheilopalatoschisis Concomitant use with other antiepileptic drugs further increases the risk. | Use must be based on a serious indication Start folic acid supplementation 0.4-4 mg already when planning pregnancy. From week 12 of pregnancy onwards the daily dose should not exceed 0.4 mg. Structural ultrasound examination at week 19-21 of pregnancy |
Miscarriage, foetal death | Detrimental at every stage of pregnancy | |
| Others | ||
Ethanol | Miscarriage, malformations, delayed growth, developmental delay | Detrimental at every stage of pregnancy |
Doses used for the treatment of systemic mycosis: aberrant skeletal development, cheilopalatoschisis, cardiac defects | Single dose used to treat vaginal candidiasis (150 mg) associated with an increased risk of miscarriage / foetal death. | |
Genotoxic potential Clearly teratogenic in animal tests | Reliable contraceptive precautions must be taken. Men: a withdrawal period of 3 months is recommended before attempting pregnancy. | |
Narcotics | Malformations, prematurity, bleeding, infections, withdrawal symptoms in the neonate | Detrimental at every stage of pregnancy |
Teratogenic in animal tests | 2-year withdrawal period before stopping reliable contraception Acceleration of elimination by cholestyramine or medicinal charcoal | |
A thalidomide analogue Teratogenic in animal tests (primates) | Restrictions and precautions as for thalidomide | |
Low risk of aberrant cardiac development (risk of Ebstein's anomaly < 0.1%) | May be used with clear indications during pregnancy After exposure in early pregnancy foetal cardiac ultrasonography at about the 20th week of pregnancy Drug concentration to be monitored | |
Methimazole embryopathy: absence of nostrils, oesophageal atresia, congenital local aplasia cutis Possible risk is low | In early pregnancy, consider carefully the necessity of the medication. Changing to propylthiouracil (PTU) may be considered case by case if possible from the therapeutic viewpoint. Change back to carbimazole at the beginning of the second trimester. Optimal treatment of hyperthyroidism is important. | |
Folate antagonist Miscarriage, malformations of multiple organs (CNS, cranium and other bones, heart) Malformation risk associated with low-dose therapy about 2-fold compared to "background risk" (absolute risk 6-7%) | Contraindicated during pregnancy.
Withdrawal periods: after a single dose no clear justification for any specific withdrawal period;
after repeated dosage for the treatment of chronic diseases withdrawal period 3 months before the beginning of pregnancy; folic acid prophylaxis important
Men: In low-dose treatment risk through the man theoretical, not confirmed. For doses used for the treatment of cancer: see Cytotoxic drugs Folic acid prophylaxis important also for men | |
Misoprostol (for gastric ulcer, also used for medical abortion) | Miscarriage Aberrant limb development, ankylosis, damage to cranial nerve nuclei (Möbius syndrome) | There is an NSAID preparation available that contains misoprostol to prevent gastric symptoms Initiated medical abortion should be completed. |
Risk of significant malformation is about 20-25%. Risk of miscarriage is 40%. Malformations in the ear area, eyes and heart, cheilopalatoschisis | Reliable contraceptive precautions should be taken during the treatment and for 6 weeks after withdrawing the medication. Risk through the man is theoretical, not confirmed. | |
In single studies an association with cardiac defects has been found, but the connection has not been confirmed. Withdrawal symptoms of the newborn infant | The time between birth and the occurrence of withdrawal symptoms may be several days/weeks. | |
Pharmaceutical agents affecting the renin-angiotensin system (ACE inhibitors, ATR blockers, renin inhibitors) | Risk of foetal kidney damage | The risk is related to use in 2nd and 3rd trimesters. Medication must be changed when planning pregnancy or no later than when pregnancy is confirmed. |
Teratogenic in animal tests | A withdrawal period of at least 4 months before stopping reliable contraception Manufacturer recommends for male patients a withdrawal period of at least 7 months. The risk through a man is theoretical, not confirmed. | |
Malformations, miscarriage, delayed growth | Women:
After stopping the medication, a withdrawal period is needed before pregnancy begins.
The length of the withdrawal period depends on the underlying disease and on the pharmacokinetics of the drug.
Cytotoxic treatment possible from the 16th week of pregnancy onward if clearly indicated.
Men:
For cancer treatments, a withdrawal period of at least 1.5 years is recommended; in case of a low-dose treatment, as far as possible, a 3- to 6-month withdrawal period
The limited experience has not, however, shown a significant risk in pregnancies that have started during the father's treament or within the withdrawal period.
| |
No effect on the total incidence of malformations Cardiac malformations somewhat more common in pregnancies in fluoxetine (ventricular septal defects) and paroxetine users (right ventricular outflow tract obstruction defects) Adaptation problems in the neonate (breathing difficulty, increased tonus) Pulmonary hypertension more common in neonates born to mothers who have taken SSRIs (3:1 000) than in unexposed neonates (1-2:1 000) | The absolute increase in the risk of specific cardiac malformations is small (< 1%) and no causal connection has been confirmed. Medication should not be routinely stopped in late pregnancy if it is important for the mother. The neonate should be monitored at least up to the age of 2 days. There is contradictory information on the possible long-term effects on children's neurocognitive and neuropsychiatric development. | |
Risk of severe malformation > 50% Risk of miscarriage 40-50% Multiple organ malformations: partial or complete symmetric lack of limbs, eye and ear anomalies, renal and urinary tract anomalies. | New indications (leprosy, autoimmune diseases, metastatic cancers, secondary symptoms associated with AIDS) Close supervision of the use of the drug is necessary. Reliable contraception is necessary. Men: thalidomide is excreted in sperm; the manufacturer recommends the use of condoms. | |
Enamel damage of deciduous teeth, accumulation in the skeleton | Risk of enamel damage of deciduous teeth from the 16th week of pregnancy onward | |
Folate antagonist | Use should be avoided when planning pregnancy and during the first trimester. | |
Possible adverse effect on fertility during course of medication Adverse effect on the renal function of the foetus from week 20 of the pregnancy onwards and on the circulatory system (premature closure of the ductus arteriosus) of the foetus from the week 28 of the pregnancy onwards | Rupture of the ovarian follicle and implantation of the embryo in the uterus are events depending on prostaglandin synthesis. Repeated and regular use should be avoided from the 20th week of pregnancy onward. COX-2 inhibitors should not be used during pregnancy. | |
Acetylsalicylic acid (ASA), analgesic doses: in addition to the above, risk of peripartal bleeding (mother and child) | There are no special risks associated with low dose ASA. | |
Aberrant bone and cartilage development, foetal bleedings | Medication must be changed by no later than the beginning of the 6th week of pregnancy (4th foetal week). | |